Clinic at Children's Hope in Action (CHIA)

We have been lucky enough to staff the pediatric clinic at Children's Hope in Actions (CHIA, http://www.childrenshopeinaction.org), a charity in Hoi An run by Robyn Morley.  The clinic is managed by Ms. Thao and Sagen Wilks.  We have been working with them for many years and have seen a number of children with various conditions like seizures/epilepsy, congenital heart conditions (like VSDs, Tetralogy of Fallot and TGA) , intra-uterine infections with Rubella, low blood counts and kidney problems.  We utilize a wide network of specialists both for diagnosis and management in the complex cases.

Three conditions we see a lot of deserve special mention.  Seizure disorders in children (whether it be febrile seizures, those associated with disorders of brain development or those without cause) are difficult to manage in Viet Nam.  Seizures are not viewed in the same way they are in the west and often tolerated by families.  There are prevailing concerns about medication side effects and getting families to titrate up on anti-epileptics to stop seizures is an ongoing battle - many children have ongoing seizures on low dose medications.  Intrauterine infections with Rubella is a problem in Viet Nam.  Rubella is not part of the routine vaccination schedule and, when mothers acquire it during pregnancy, children can be born with heart defects, cataracts and deafness.  We have seen a few children at CHIA with this condition which usually requires surgeries both for the cataracts and the heart defects.  Often these children require lifelong care by their families.  There is an initiative to vaccinate Vietnamese (http://www.measlesrubellainitiative.org/) to help prevent these problems in the future.

Finally, rheumatic fever (a systemic inflammatory condition following an infection with Streptococcus that can affect the heart valves) is common and both our foundation and CHIA have found a number of cases.  You can help prevent progression of the valve problem with daily prophylactic penicillin (though some cases require surgery).

Getting the families to give the children a daily tablet for 10 years (the recommended duration of medication) when they do not feel poorly is an ongoing challenge.  Vietnam needs a national program to work on prevention of rheumatic fever by appropriate treatment of Strep infections.

These are some of the issues that CHIA is working on in their clinic. The children are wonderful as are the families.  CHIA has done a great job in providing support for these children and their families and we are happy to help.

NCD Management in Viet Nam

I spent the morning with An and Yen in one of the clinics where our model for NCD management has been implemented.  There is a nurse practitioner seeing the patients and titrating medications for the patients with hypertension and diabetes.  Our staff monitors her progress, helps her with patient education and assists in following the protocol.  She reviews some of the more complicated cases with me and we discuss management strategies.  This clinic is doing a great job with these patients!  They are conscientious and caring.  They thank us for the increased knowledge and equipment to take better care of their patients.  The patients also are happy for the education and to get more time with their health providers.  Blood pressures and sugars are improving using the provided algorithms.  This model of rural commune clinic management of hypertension and diabetes is the key to getting control of the rapid increase in these conditions and the subsequent cardiovascular disease (the leading cause of death in Viet Nam).  The average rural Vietnamese patient with the chronic diseases will not travel to the distant hospital where there is overcrowding, long waits, short visits, little in the way of teaching and no scheduled followup (not to mention that most of the chronic diseases dont make them feel "bad" so convincing them to travel distances for management is tough).   A model for local management of these cases is what we are working on and what this clinic is doing well. Translating these small achievements at a local clinic into nationwide change in practice style is our challenge for the next few years.

Josh Solomon